Employee Manual 2023 - Flipbook - Page 55
time to read this notice carefully.
Qualified Beneficiary: The term “Qualified Beneficiary” refers to individuals who are covered
under the City’s group health plan the day before a COBRA Qualifying Event takes place. According
to the COBRA statute, a Qualified Beneficiary is the covered employee, covered spouse of the
employee, covered dependent child of the employee or any child born to, or placed for adoption
with, the covered employee during the period of continuation coverage, if the covered employee
elects COBRA and if the child is enrolled in the plan (together “covered dependents”).
Coverage That May be Continued: COBRA continuation coverage(s) applies to
Medical/Prescription, Dental and Vision.
COBRA Continuation Coverage: Under certain circumstances, you and/or your covered dependents
have the right to continue participation in the Plan, beyond the time coverage would normally end
(“Continuation Coverage”). The following (including the “Special Rules for COBRA Continuation
Coverage”) is a complete description of the circumstances that give rise to Continuation Coverage.
Continuation Coverage is available if you are enrolled in the Plan and you or your covered
dependent’s enrollment would end because:
1. You voluntarily end your employment with the City;
2. Your employment is voluntarily terminated by the City for a reason other than your gross
misconduct;
3. Your hours of work are reduced so that you are no longer eligible for group health plan
coverage;
4. You become divorced or legally separated;
5. You die;
6. Your child is no longer eligible to be a dependent;
7. You become entitled to Medicare; or
8. The bankruptcy of the City.
The above reasons are referred to as “Qualifying Events”.
Notification Responsibilities: If coverage will end because of divorce or legal separation, or
because a child is no longer eligible to be a dependent, you or your covered dependent must notify
the City’s human resources director immediately. If the Plan Sponsor (the City) is not notified
within sixty (60) days after coverage would otherwise end, coverage cannot be continued.
When the City receives your notice (or when your employment ends, your hours of work are
reduced so you are no longer a full-time employee, or you die), you and your covered dependents
will be notified by the City within 14 days about the right to continue coverage. If you or a covered
dependent(s) want to continue group health plan coverage, the election of coverage must be made
within sixty (60) days of the date the COBRA notice was sent to you.
Individuals Covered: You and each of your covered dependents can individually decide whether or
City of Plymouth Employee manual - Page 55 – March 2023
